Enrollment Form

assignment 500 FORM No. 469-(2) THE AMERICAN RED CROSS ENROLLMENT FORM M W Voyage number From To THE DIVISION OF TRANSPORTATION, Nursing Department BUREAU OF PERSONNEL. CLIB Date 4-5-18 assmal Approval of Director, Bureau of Personnel J.P.K. Approved James a. reland 1. Name Von Kurowsky, Agnes 2. Address 272 Manhattan Ave. New York City 3. Temporary address, if any 4. Going to what countries Italy 5. Nature of work Nursing 6. Suggested rank 7. Length of stay (six months or over?) 1 year or 8. Proposed approximate date of departure Arpil more Booked. 20th Apr. 20 (Crs) Sailed 6/15 9. Cable number in compliance with which above is being sent 10. Is appointee volunteer? I52 or gum No. 11. If not volunteer, what salary per month is promised? $ 60.00 12. To begin date of sailing 13. What allowance, if any, for transportation in United States? $ in New York, Not necessary 14. What allowance, if any, for transportation (steamship)? Yes, both ways 15. What allowance, if any, for living expenses prior to departure? $ none 16. What allowance, if any, for uniform equipment? $ yes, regulation equipment 17. What allowance, if any, for living expenses abroad? $ yes, regulation allowance 18. Is there to be an assignment of part or all of salary? 19. Has the proper form been sent to the Life Extension Institute? Division of Transportation, PLEASE LEAVE THE FOLLOWING LINES BLANK. Correspondence checked: Note Forms 1-2-25 4/8/18 G-ac-, 4/8 Mailed 4/8/18 Clerk of the Court at Application for passport filed Date Issued Reservation Cancelled Cabled Cancelled